Information Collection

NHSC Recruitment and Retention Assistance Application

IC 6469 under ICR 201406-0915-003 · OMB 0915-0230.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SiteAdministratorPortalUserGuide.pdf	Instruction
1 Site Administrator Portal Guide SiteAdministratorPortalUserGuide.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			SiteAdministratorPortalUserGuide.pdf		Yes	No	Printable Only
Form and Instruction	1	Site Administrator Portal Guide	SiteAdministratorPortalUserGuide.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	1,500	1,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.